ORIGINAL ARTICLE Journal of the College of Physicians and Surgeons Pakistan 2021, Vol. 31(07): 817-820 817 Role of Intravenous Magnesium Sulphate in Term Neonates with Hypoxic Ischemic Encephalopathy (HIE) in a Low-income Country: A Randomised Clinical Trial Muhammad Asif Siddiqui and Tayyaba Khawar Butt Department of Paediatric Medicine Unit-II, Services Hospital, Lahore, Pakistan ABSTRACT Objective: To determine the effects of magnesium sulphate in term neonates with hypoxic ischemic encephalopathy (HIE) in reducing mortality and morbidity. Study Design: Randomised clinical trial. Place and Duration of Study: Department of Neonatology, Services Hospital, Lahore, Pakistan from April to December 2019. Methodology: Term babies (inborn or outborn), fulfilling the operational definition of hypoxic ischemic encephalopathy, reaching within 6 hours of delivery in Nursery Department of Pediatric Medicine Unit-II, Services Hospital, Lahore, were included. Sarnat score was used for staging the severity of HIE. Cases were administered magnesium sulphate (MgSO4) as intra- venous infusion. Rest of the management was similar for cases and controls. Mortality was defined as death due to birth asphyxia; whereas, morbidity was assessed by comparing the following at discharge: the grade of hypoxic ischemic encephalo- pathy, presence and frequency of seizures, duration of seizures, ability to suck feed and neurological problems such as abnor- malities of muscle tone and neonatal reflexes. Babies with prematurity, dysmorphism comorbidities or arriving after 6 hours of birth, were excluded. Chi-square test was used for comparison; and p value <0.05 was considered significant. Results: Gender, mode of delivery, mode of resuscitation at birth, major risk factors (prolonged labour, premature rupture of membranes, presence of meconium-stained amniotic fluid) were comparable in both groups. The duration of seizures, ability to suck feed and presence of neurological problems at discharge were significantly better in magnesium sulphate group as compared to control group. Conclusion: Magnesium sulphate is better in establishing earlier suck feed and reducing the duration of seizures and neurolog- ical problems in babies with birth asphyxia. Key Words: Hypoxic ischemic encephalopathy, Magnesium sulphate, Outcome, Term, Low income country How to cite this article: Siddiqui MA, Butt TK. Role of Intravenous Magnesium Sulphate in Term Neonates with Hypoxic Ischemic Encephalopathy (HIE) in a Low-income Country: A Randomised Clinical Trial. J Coll Physicians Surg Pak 2021; 31(07):817-820. INTRODUCTION In Pakistan, neonatal mortality and morbidity is remarkably high. Birth asphyxia is one of the main contributors to this, apart from prematurity, sepsis and other causes. 1,2 Birth asphyxia is not only responsible for mortality, but also for short term and long-term neurological complications. Moderate to severe birth asphyxia is responsible for about 40%mortalityandmorbidity. 3-5 Correspondence to: Dr. Muhammad Asif Siddiqui, Depart- ment of Paediatric Medicine Unit-II, Services Hospital, Lahore, Pakistan E-mail: drmasifrmc@gmail.com ..................................................... Received: April 08, 2021; Revised: June 09, 2021; Accepted: June 25, 2021 DOI: https://doi.org/10.29271/jcpsp.2021.07.817 Though hypothermia therapy or hypothermia with other adjuncttherapies,likemagnesiumsulphate,hasbeenrecom- mended in moderate to severe hypoxia; but there is no optimaltreatmentmodalityavailableforbirthasphyxiainlow- incomeresource-deprivedsettings,apartfromgivingsuppor- tiveandsymptomatictreatment. 6 Althoughhypothermiaisan established treatment, lack of trained nursing staff is a hindrance in implementing it on a wide scale. Magnesium sulphate is cost-effective and readily available, and is easily administered in comparison to cooling therapy. Because of the relative ease with which it can be used, it may have a beneficial role in management of HIE even in resource-de- prived neonatal units. Despite its potential benefit, very few localstudiesareavailableonitsuse. The objective of this study was to determine the beneficial effects if any, of magnesium sulphate in term neonates with birthasphyxiaintermsofmorbidityandmortality.